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Monitoring and Medicines for Heart Failure

Topic Overview

Heart failure is most often a lifelong
illness that will require frequent changes in your medicine schedule and
regular follow-up with your doctor. Over the years, many things will affect
the course of your disease, including other illnesses that you develop, your
age, your diet, your ability to tolerate and comply with your treatment, and
hopefully the development of new drugs to treat heart failure.

Several important aspects of monitoring the course of your illness will
help you to optimize your treatment:

Regular follow-up with your doctor. How often you need to see your doctor will vary depending on the
severity of your symptoms at any given time. It is possible that you will be
able to get on a stable medical regimen for years and may only need to see your
cardiologist 2 or 3 times a year. At other times you may need to see the doctor
as frequently as once a week. A good example of this would be when you start to
take beta-blockers. These medicines can initially make heart failure symptoms
worse and can cause low blood pressure and a slow heart rate, so you will need
to be seen frequently to make sure the process of taking medicine goes
smoothly.

Keeping track of your exercise tolerance and your symptoms. This is an important way for you and your doctor to
monitor the severity of your heart failure. You can help keep track of this by
keeping a record of how much exercise you can do and what types of activities
you can do without symptoms. An accurate assessment of your exercise tolerance
will help you and your doctor decide whether changes need to be made in your
medical regimen.

Monitoring your electrolytes. Several of the medicines for heart failure can affect important
electrolytes or minerals in the blood. Most importantly, diuretics can lower
the amount of potassium and magnesium in the blood and can also decrease sodium
and calcium. Low potassium, magnesium, or calcium can all raise your risk of
having a dangerous ventricular arrhythmia. Angiotensin-converting enzyme (ACE)
inhibitors, angiotensin II receptor blockers (ARBs), and spironolactone, on the
other hand, can increase the level of potassium in your blood. If you are
taking these medicines, it will be important for you to periodically have these
electrolytes measured using a blood test. They should also be measured shortly
after you start taking any new medicine.

Watching for side effects of your medicines.
All medicines have side effects. Ask your doctor or pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
If you
develop any of these expected side effects or any new symptoms that you think
can be attributed to one of the medicines that you are taking, it is important
that you discuss the problem with your doctor immediately.

Monitoring your blood pressure and heart rate. Your blood
pressure and heart rate are extremely important parameters that affect how well
your heart can function and reflect how well your medicines are working.
If you take your blood pressure and heart rate at home, keep a record to share with your doctor at your regular visits. Your doctor can
give you a range of blood pressure and heart rates that are acceptable for you
and instructions on what to do if your measurements are outside these
ranges.

Monitoring your weight. Your weight
is a direct indication of how much fluid you have in your body. With heart
failure, you will always have a tendency to retain salt and water. You should
record your weight daily. Call your doctor if you notice a sudden weight gain.
Your doctor may tell you how much weight to watch for. But in general, call
your doctor if you gain
3 lb (1.4 kg) or more in 2 to 3
days. The medicine that most directly affects the amount of fluid in your body
is your diuretic. If your weight drifts up quickly, you may need to take more
diuretic; if your weight drifts down quickly, you may need to take less.

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How this information was developed to help you make better health decisions.